Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
School of Rural Medicine, University of New England, Armidale, Australia.
PLoS One. 2024 Aug 29;19(8):e0305605. doi: 10.1371/journal.pone.0305605. eCollection 2024.
Chronic kidney disease (CKD) affects up to 11% of the population. General practice is at the forefront of the identification of patients with declining kidney function, and appropriate monitoring and management of patients with CKD. An individualized and patient-centred approach is currently recommended in guidelines, but would be enhanced by more detailed guidance on how this should be applied to different age groups, such as use of a kidney trajectory chart. We explored the opinion of general practitioners (GPs) about the potential utility of kidney trajectory charts.
Qualitative study interviewing 27 Australian GPs about their management of chronic kidney disease. GPs were presented with charts that plotted percentiles of kidney function (eGFR) with age and discussed how they would use the charts manage to patients with declining kidney function. GPs' opinion was sought as to how useful these charts might be in clinical practice.
Most GPs were positive about the use of kidney trajectory charts to assist them with recognition and management of declining kidney function in general practice: e.g, comments included a "valuable tool", "a bit of an eye opener"," will help me explain to the patients", "I'll stick it on my wall.". GPs responded that the charts could help monitor patients, trigger early recognition of a younger patient at risk, and assist with older patients to determine when treatment may not be warranted. GPs also thought that charts could also be useful to motivate patients and help them monitor their own condition.
Use of percentile charts in conjunction with the current CKD guidelines help support a patient-centred model of care. Kidney trajectory charts can help patients to understand their risk of further kidney damage or decline. Research on the use of these charts in clinical practice should be undertaken to further develop their use.
慢性肾脏病（CKD）影响了多达 11%的人口。全科医生处于识别肾功能下降患者的第一线，对 CKD 患者进行适当的监测和管理。目前指南中推荐采用个体化和以患者为中心的方法，但如果能有更详细的指导来阐明如何将其应用于不同年龄组，例如使用肾脏轨迹图，则会有所帮助。我们探讨了全科医生对肾脏轨迹图潜在应用价值的看法。
采用定性研究，访谈了 27 名澳大利亚全科医生，了解他们对慢性肾脏病的管理情况。向全科医生展示了描绘肾功能（eGFR）随年龄变化的百分位数的图表，并讨论了他们如何使用这些图表来管理肾功能下降的患者。征求了全科医生对这些图表在临床实践中可能有用程度的意见。
大多数全科医生对使用肾脏轨迹图来协助他们在全科实践中识别和管理肾功能下降持积极态度：例如，有“很有价值的工具”、“令人大开眼界”、“有助于我向患者解释”、“我会把它贴在墙上”等评价。全科医生认为这些图表可以帮助监测患者，及早识别有风险的年轻患者，并帮助老年患者确定何时可能不需要治疗。全科医生还认为，图表还可以帮助患者自我激励并监测自己的病情。
将百分位图表与当前的 CKD 指南一起使用，可以支持以患者为中心的护理模式。肾脏轨迹图可以帮助患者了解自己进一步肾脏损伤或下降的风险。应该开展这些图表在临床实践中的应用研究，以进一步开发其应用。
